Loading...
By-law No. 2007-123 CORPORATION OF THE MUNICIPALITY OF BAYHAM BY-LAW NO.2007-123 BEING A BY-LAW TO AUTHORIZE THE EXECUTION OF AN AGREEMENT BETWEEN THE MUNICIPALITY AND MINISTRY OF HEALTH AND LONG-TERM CARE WHEREAS the Municipality of Bayham has applied to the Ministry of Health and Long-Term Care under the "Grow Your Own NP Initiative" for funding support for the position of Nurse Practitioner; AND WHEREAS it is deemed necessary to enter into an Agreement with the Ministry of Health and Long-Term Care for the provision of funding support under the "Grow Your Own NP Initiative"Program to the Municipality of Bayham. THEREFORE THE COUNCIL OF THE CORPORATION OF THE MUNICIPALITY OF BAYHAM ENACTS AS FOLLOWS. 1. THAT the execution of an Agreement with the Ministry of Health and Long-Term Care under the"Grow Your Own NP Initiative"be and the same is hereby authorized. 2. THAT this by-law shall come into full force and effect upon final passing. READ A FIRST, SECOND AND THIRD TIME AND FINALLY PASSED this 20th day of December 2007. elan /U1 L.IMAYO RK M M te and - Healthrm et dist So de long C::) nta r i o and Long-Term Care et des Soins de longue duree C7S7 Primary Health Care Renouvellement des coins primaires Primary Health Care and Equipe de renouvellement des coins Famiry Health Teams primaires et equipes Sante familiale Health System Accountability Division de la responsabilisation et de and Performance Division la performance du systOme de sante 80 Queen Street,3rd Floor 80,rue Queen,3e r tage Kingston ON K7K 6W7 Kingston ON K7K 6W7 Tel: 613 650-5444 Tel.: 613 650-5444 Fax: 613 650-5440 Telec: 613 650-5440 January 14, 2008 Municipality of Bayham 9344 Plank Road Straffordville ON NOJ 1Y0 Attention: Margaret Underhill, Planning Coordinator-Deputy Clerk Dear Ms. Underhill: Re: Nurse Practitioner Funding Agreement under the Grow Your Own Nurse Practitioner ("GYONP") Initiative — Municipality of Bayham ("Organization") EIgi104 The Ministry entered into an agreement with the Organization dated September 1, 2006 to facilitate the education of a nurse practitioner (the "GYONP Agreement"), attached to this Agreement as Schedule "E". Pursuant to the GYONP Agreement, the Ministry, the Organization and the Nurse Practitioner entered into a Return of Service Agreement (the "ROS Agreement"), attached to this Agreement as Schedule "F", whereby the Nurse Practitioner agreed to provide Services for the Organization for a two-year period following her registration as a nurse practitioner. This letter sets out the terms and conditions governing the funds the Ministry shall provide to the Organization for the Nurse Practitioner's Services for the term of the ROS Agreement. Definitions 1 . In this Agreement, the following words shall have the following meanings: "Agreement" means this agreement between the Ministry and the Organization, all schedules attached to this Agreement and any instrument amending this Agreement. Elgi104 GYO PCNP Page 1 of 12 Municipality of Bayham "Budget" means the budget attached as Schedule "B" "CNO" means the College of Nurses of Ontario. "Collaborating Physician" means the physician with whom the Nurse Practitioner enters into an agreement pursuant to subsection 9(d). "Fiscal Period" means: (a) in the case of the first Fiscal Period, the period commencing November 1, 2007 and ending on the first day that is March 31 following the date of this Agreement; and (b) in the case of Fiscal Periods subsequent to the first Fiscal Period, the period commencing on the date that is April 1 following the end of the previous Fiscal Period and ending the following March 31 "Funds" means the funds described in section 3. "Ministry" means the Ministry of Health and Long-Term Care. "Nurse Practitioner" means Kristal Pitter RN(EC). "Nurse Practitioner Records" means all records and documents created by the Nurse Practitioner in providing the Services. "Nursing Act" means the Nursing Act, 1991, S.O. 1991, c. 32. "Organization" means the Municipality of Bayham. "Organization Records" means all records, invoices and other documents created by or belonging to the Organization that relate to the Funds and the operation of the Program. "Program" means the program described in section 8 of this Agreement. "Resident" has the meaning ascribed to in the Health Insurance Act, R.S.O, 1990, c. H.B. "Service Area" means in the Municipality of Bayham. "Services" means primary health care services that the Nurse Practitioner is authorized by law to perform. Blgi 104 GYO PCNP Page 2 of 12 Municipality of Bayham Term 2. This Agreement shall commence on November 1, 2007 and shall end on October 30, 2009 unless terminated earlier pursuant to section 21, 22 or 24 of this Agreement. The Funds 3. Subject to section 27, the Ministry shall, in each Fiscal Period provide to the Organization the Funds specified in the Budget for the provision of Services. Based upon the reports provided to the Ministry pursuant to section 16, the Ministry shall, for each Fiscal Period, subsequent to the first Fiscal Period, approve a budget that shall be deemed: (a) to be the Budget in respect of the succeeding Fiscal Period to which it relates; (b) to replace the Budget for the prior Fiscal Period; and (c) to form Schedule "B" to this Agreement. 4. The Ministry shall make payments to the Organization in monthly instalments: (a) in the amount listed in the Budget; (b) by direct deposit into a bank account designated by the Organization; and (c) on the last business day of each month. 5. If the Nurse Practitioner does not begin work on the first business day of the month, the Ministry shall prorate the first payment to reflect the time the Nurse Practitioner worked during the first month. 6. The Organization shall only use the Funds to operate the Program in accordance with this Agreement and shall expend the Funds only in accordance with the Budget. 7 The Organization shall not move Funds from one Budget category to another without the prior written consent of the Ministry. Elgi 104 GYO PCNP Page 3 of 12 Municipality of Bavham The Program 8. The Organization shall operate a Program for the provision of primary care services that ensures that Residents of the Service Area, who are patients of the Organization, receive the Services of the Nurse Practitioner on a full-time basis (where full-time is interpreted to mean a minimum of 35 hours per week, exclusive of absence due to vacation, sickness and other reasons for absence that are reasonably deemed acceptable by the Organization), at times that are commensurate with the needs of the community in the Service Area. 9. In operating the Program, the Organization shall: (a) engage the services of the Nurse Practitioner to provide the Services; (b) ensure that the Nurse Practitioner is, and continues to be for the duration of the Agreement, a member of the CNO who holds an extended certificate of registration under the Nursing Act; (c) ensure that the Nurse Practitioner maintains for the period during which the Nurse Practitioner provides Services, malpractice protection in the amount of not less than $5,000,000 on an occurrence basis; (d) ensure that the Nurse Practitioner enters into an agreement with a Collaborating Physician for the period during which the Nurse Practitioner provides Services, for the purposes of, and to cover the matters outlined in, Schedule "A"; (e) use its best efforts to ensure that the Nurse Practitioner: (i) only provides Services for the benefit of Residents; (ii) does not charge any Resident any fee for any Service; (iii) meets the Nurse Practitioner's professional obligations as described in the Standards for Consultation. with Physicians by RNECs, issued by the CNO; (iv) provides all Services in compliance with all federal, provincial and municipal laws and regulations, and any orders, rules and by-laws related to any aspect of the Services; (v) keeps and maintains all Nurse Practitioner Records in a manner consistent with generally accepted accounting principles or clerical practices, as the case may be; Elgi 104 GYO PCNP Page 4 of 12 Municipality of Barham (vi) maintains all Nurse Practitioner Records and keeps them available for review by the Organization and the Ministry for a period of seven (7) years from the date of the termination or expiry of this Agreement; and (vii) maintains all Nurse Practitioner Records that contain personal information about the people to whom the Nurse Practitioner provides Services, in a confidential manner consistent with all applicable laws; (f) continue to contribute to the operation of the Program for the period during which this Agreement is in effect, which contribution shall be satisfactory to the Ministry; (g) keep and maintain all Organization Records in a manner consistent with generally accepted accounting principles or clerical practices, as the case may be; (h) maintain all Organization Records and keep them available for review by the Ministry for a period of seven (7) years from the date of the termination or expiry of this Agreement; (i) allow the Ministry, upon twenty-four (24) hours' notice and during normal business hours, to enter upon the Organization's premises to inspect and copy any Organization's Records in the possession or under the control of the Organization which relate to the Funds; and (j) acquire all equipment, supplies and services (other than Services) it purchases with the Funds through a process that ensures the best value for funds expended. Additional Terms and Conditions 10. The Ministry shall be entitled, at any time, to impose such additional terms or conditions on the Organization that it considers appropriate for the proper expenditure and management of the Funds and the operation of the Program. Inspection and Audit 11 . The Ministry's right of inspection in this Agreement includes the right to perform an audit of any kind including a review or examination of any aspect of the Program or the Services or any Organization Records. 12. To assist the Ministry to carry out its inspection under this Agreement, the Organization shall provide any other information to the Ministry reasonably requested by the Ministry. Elgi 104 GYO PCNP Page 5 of 12 Municipality of Bayham 13. The purposes for which the Ministry may exercise its inspection and audit rights include: (a) determining for what items and purposes the Organization is expending or has expended the Funds; and (b) determining whether the Organization is operating the Program effectively and in accordance with the terms of this Agreement. 14. Nothing in this Agreement shall require the Organization, except as otherwise permitted or required by law, to disclose any personal information, or any personal health information or records to the Ministry. 15. No right conferred upon the Ministry under the Agreement nor any provision of the Agreement shall be construed so as to give the Ministry any control whatsoever over the Organization Records or the Nurse Practitioner Records. Reports 16. The Organization shall submit to the Ministry the reports listed in Schedules "C" and "D", on the dates listed in Schedules "C" and "D", and such other reports as the Ministry may request from time to time. 17. The Organization shall ensure that all reports are in a form satisfactory to the Ministry. Indemnification 18. The Organization shall indemnify and hold harmless the Ministry, its officers, employees and agents for any incidental, indirect, special or consequential damages, or any loss of use, revenue or profit, by any person, entity or organization including the Organization, arising out of or in any way related to this Agreement. Insurance 19. The Organization shall put into effect and maintain for the period during which the Agreement is in effect, at its own expense, all the necessary insurance that would be considered appropriate for an organization operating a Program of this kind, including: (a) Commercial General Liability Insurance, to an inclusive limit of not less than Two Million Dollars ($2,000,000) per occurrence for property damage, bodily injury and personal injury, and including, at least, the following policy endorsements: Elgi 1 O4 CYO PCNP Page 6 of 12 Municipality of Bayham (i) Her Majesty the Queen in right of Ontario as represented by the Ministry of Health and Long-Term Care, as an additional insured with respect to the operation of the Program provided and the provision of Services under this Agreement; (ii) a cross-liability clause endorsement; (iii) a contractual liability endorsement; and (iv) a 30 day written notice of cancellation. 20. Upon request of the Ministry, the Organization shall provide the Ministry with proof of insurance. Termination 21. Either party, at any time, without reason and without liability, cost or penalty, may terminate this Agreement upon giving 90 days' written notice to the other party. 22. The Ministry may, in its sole discretion, without liability, cost or penalty, and without prejudice to any other rights or remedies of the Ministry under this Agreement, any other agreement, at law or in equity, terminate this Agreement immediately upon giving written notice to the Organization if: (a) in the opinion of the Ministry: (i) the Organization breaches any term or condition of this Agreement; (ii) the Organization is unable to operate the Program; (iii) the Organization enters into another agreement with the Ministry for the same or similar purposes; (iv) the ROS Agreement is terminated; (v) the Organization breaches any term or condition of either the GYONP Agreement or the ROS Agreement; (vi) the Nurse Practitioner breaches any term or condition of the ROS Agreement; or (vii) the Nurse Practitioner ceases to provide Services for the Organization in accordance with the terms of the ROS Agreement; or if: Elgi 144 GYO PCNP Page 7 of 12 Municipality of Bayham (b) the Organization makes an assignment, proposal, compromise, or arrangement for the benefit of creditors, or is petitioned into bankruptcy, or files for the appointment of a receiver; or (c) the Organization ceases to operate. 23. If the Ministry, in its sole discretion, considers the nature of the breach referred to in section 22(a)(i), section 22(a)(v) or section 22(a)(vi) to be such that it can be remedied and that it is appropriate to allow the Organization the opportunity to remedy the breach, the Ministry may give the Organization an opportunity to remedy the breach by giving the Organization written notice: (a) of the particulars of the breach; (b) of the period of time within which the Organization is required to remedy the breach; and (c) that the Ministry shall terminate this Agreement: (i) at the end of the notice period provided for in the notice if the Organization fails to remedy the breach within the time specified in the notice; or (ii) prior to the end of the notice period provided for in the notice if it becomes apparent to the Ministry that the Organization cannot completely remedy the breach within that time or such further period of time as the Ministry considers reasonable, or the Organization is not proceeding to remedy the breach in a way that is satisfactory to the Ministry. 24. If the Ministry has provided the Organization with an opportunity to remedy the breach, and: (a) the Organization does not remedy the breach within the time period specified in the notice; (b) it becomes apparent to the Ministry that the Organization cannot completely remedy the breach within the time specified in the notice or such further period of time as the Ministry considers reasonable; or (c) the Organization is not proceeding to remedy the breach in a way that is satisfactory to the Ministry, the Ministry shall have the right to immediately terminate this Agreement by giving notice of termination to the Organization. E1gil04 GYO PCNP Page 8 of 12 Municipality of Bayham 25. In the event of termination pursuant to section 24, the effective date of termination shall be the last day of the notice period, the last day of any subsequent notice period or immediately, which ever applies. Suspension of Funding 26. Despite its right to terminate the Agreement pursuant to sections 21 , 22 and 24, the Ministry may choose not to terminate the Agreement and may choose to suspend Funding under the Agreement for such period as the Ministry determines necessary and appropriate. Funding Upon Termination 27. If this Agreement is terminated by the Ministry or the Organization (as the case may be) pursuant to section 21, 22 or 24, the Ministry shall: (a) cancel all further Funding instalments; (b) demand the payment of any Funds remaining in the possession or under the control of the Organization; and (c) demand the payment of monies equal to any Funds uses uy the Organization for purposes not agreed upon by the Ministry. Funding at end of Fiscal Period and Upon Expiry 28. If, at the end of any Fiscal Period or upon the expiry of the Agreement: (a) the Organization has not spent all of the Funds allocated as provided for in the Budget; or (b) the Organization has used Funds for purposes not agreed upon by the Ministry, the Ministry may demand the payment of the unspent Funds or monies equal to any Funds used for purposes not agreed upon by the Ministry, and the Organization shall pay them immediately to the Ministry. Debts Owing to the Ministry 29. If the Ministry demands the payment of any Funds or monies pursuant to this Agreement, the amount demanded shall be deemed to be a debt due and owing to the Ministry and the Organization shall pay the amount to the Ministry immediately unless the Ministry directs otherwise. Elgi 104 GYO PCNP Page 9 of 12 Municipality of Bavham 30. The Ministry reserves the right to demand interest on any amount owing by the Organization at the then current rate charged by the Province of Ontario on accounts receivable. 31 The Organization shall pay the amount demanded by cheque, made payable to the "Minister of Finance", and mailed to the Ministry to the attention of the Manager, Interdisciplinary Practitioner Program. Acknowledgement 32. The Organization shall acknowledge the support of the Government in all publicly distributed reports and materials and in all advertising and publicity relating to the Program, in a format approved by the Ministry. Notices 33. Any notice, consent, approval or other communication required, permitted or contemplated to be given under this Agreement shall be in writing and shall be delivered personally or by courier, sent by certified, registered or postage prepaid mail, or sent by facsimile, addressed to the other party at the address provided below or at such other address as either party shall later communicate to the other in writing in the manner provided by this section 33. All notices, consents, approvals and other communications shall be addressed as follows: To the Ministry: Interdisciplinary Practitioner Program Primary Health Care Team 80 Queen Street, 3rd Floor Kingston ON K7K 6W7 Attention: A/Manager, East and Interdisciplinary Phone: (613) 650-5444 Fax: (613) 650-5440 To the Organization: Municipality of Bayham 9344 Plank Road Straffordville, ON NOJ 1Y0 Attention: Margaret Underhill Planning Coordinator/Deputy Clerk Phone: (519) 866-5521 Fax: (519) 866-3884 Elgi104 GYO PCNP Page 10 of 12 Municipality of Bavham 34. Ail notices, consents, approvals and other communications shall be effective and deemed to have been received: (a) at the time the delivery is made when the communication is delivered personally or by courier; (b) seventy-two (72) hours after deposit in the mail when the communication is sent by certified, registered or postage prepaid mail; or (c) at the time the facsimile is received when the communication is delivered by facsimile. Schedules 35. The following schedules are attached to this letter and form part of the Agreement: (a) Schedule "A" —Terms of agreement between Nurse Practitioner and Collaborating Physician; (b) Schedule "B" — Budget; (c) Schedule "C" -- Financial Reports; (d) Schedule "D" — Performance Reports; (e) Schedule "E" — Grow Your Own Nurse Practitioner Agreement; and (f) Schedule "F" — Return of Service Agreement. Survival 36. Sections 11, 12, 13, 14, 15, 16 (to the extent any report has not been submitted in accordance with section 16), 18, 27, 28, 29, 30, 31, 36 and 38 shall survive termination or expiry of this Agreement for a period of 7 years from its termination or expiry. Entire Agreement 37. This Agreement together with the attached schedules listed in section 35 constitutes the entire agreement between the parties hereto with respect to the subject matter contained in this Agreement and supersedes all prior oral or written representations, agreements and understandings. EIgi104 GYO PCNP Page 11 of 12 Municipality of Bavham Riqhts and Remedies Cumulative 38. Except to the extent otherwise expressly stated in this Agreement, the rights and remedies of the parties are cumulative and are in addition to, and not in substitution for, any rights and remedies provided under any other agreement, at law or in equity. Please acknowledge your acceptance of the terms and conditions of this Agreement, by signing both copies of this letter and returning them to the Ministry address identified in section 33 of this Agreement. Yours sincerely, _zhilcAde/j/ Laura Pinkney A/Manager, East and Interdisciplinary On behalf of and with the authority of the Municipality of Bayham, I hereby accept the terms and conditions described above. Au hori . Signing Officer for the Municipltlity of Bayham t $ Dates /7azi-Y/Aleie;e:, Witne 5-/5r, Dat Authorized Signing Officer for the Municipality of Bayham to /i , Wit,-ss Elgi 1 D4 GYO PCNP Page 12 of 12 Schedule "A" Attached to and forming part of the agreement between the Ministry of Health and Long-Term Care and the Municipality of Bayham dated the day of 2008. Terms of Agreement between the Nurse Practitioner and the Collaborating Physician The agreement the Municipality of Baybam enters into with the Collaborating Physician(s) shall include clauses: (a) providing that the Collaborating Physician(s) shall provide ongoing professional support to the Nurse Practitioner to enable the Nurse Practitioner to meet the Nurse Practitioner's professional obligations as described in the Standards for Consultation with Physicians by RN(EC)s, issued by the CNO; (b) warranting that the Nurse Practitioner and the Collaborating Physician(s)have established a collaborative working relationship that allows the Nurse Practitioner to provide the Services and to meet the Nurse Practitioner's professional responsibilities as prescribed by law; (c) warranting that the Collaborating Physician(s) is a member in good standing of the College of Physicians and Surgeons of Ontario; (d) warranting that the Collaborating Physician(s) has and shall maintain for the period during which the Collaborating Physician(s) is engaged by the Municipality of Bayham to provide support to the Nurse Practitioner,membership in the Canadian Medical Protective Association or its equivalent; and (e) providing any other terms necessary to give effect to the obligations of the Collaborating Physician(s) described above. EIgi104 Schedule A Attachment(I) Municipality of Bayham Summary GYO NP Funding For the Period September 1,2006 to October 31,2007 (1) (2) (3) (4) (5) Approved Approved RN Interim Total Total Budget Budget Funding t April 1,2007 September 1,2006 September 1,2006 April 1,2007 1 September 1,2007 To To To To To October 31,2007 October 31,2007 March 31,2007 August 31,2007 October 31,2007 (7 Months) (5 Months) (2 Months) (2+3) 0+4) 1 (i) RN Sala Fundin: $ 30,948 $ 22,105 1 $ 8,842 $ 30,947 $ 61,895 (ii) Benefits @ 26% 8,050 5,750 1 2,300 i 8,050 16,100 (iii) RN Education Funding(Tuition+Expenses)2 - 11,500 1 - I 11,500 $ 11,500 (,s,) Total tpproved. Funding $ 38,998 $ 39,355 jr$ 11,142 $ 50,497 $ 89,495 (,) Mit P • _ \.N, ,_t; $ ' I RN Interim Funding September&October 2007 - RN Salary&Benefits: Annual Salary$53,053 (2 months @$4,421/each plus benefits @$1,150/each) Z RN Education Funding-approved one-time funding of$10,364(Tuition @$3,502 plus Other Education Costs @ $6,862)deposited November 30,2007. Elgi 104 GYO NP 2007_08 Budget Template GYO NP Funding Attachment(H) Municipality of Bayham Primary Care Nurse Practitioner Funding Request 2007-08 Expenditure Categories Annual Funding Request (i) NP Salary $ 85,320 (ii) Benefits 26% 22,184 (iii) Overhead Expenses 9,146 (iv) Total Annual Funding $ 116,650 ' Primary Care Nurse Practitioner Funding Allocation Maximum funding allocation of$116,650 and is to provide for each NP salary and benefit costs, and a portion of overhead expenses. Any additional costs beyond the maximum allocation of$116,650 will need to be planned for by the organization. . Nurse Practitioner maximum annual salary funding level of$85,320. . Benefits inclusive of statutory employee benefits(e.g. CPP,El,etc) . Overhead Expenses exclusive of funding contribution(s) and/or in kind resources received from community and or/organization. 2 Nurse Practitioner Date of Hire -November 1, 2007 Elgi104 GYO NP 2007_08 Budget Template 0708 Budget Request Schedule"B" Attached to and forming part of the Agreement between the Ministry of Health and Long-Term Care and the Municipality of Bayham dated the of Budget For the Fiscal Period November 1,2007 to March 31,2008 Maximum Approved Expenditure Categories Annual Budget Funding November 1,2007 Allocation To March 31,2008 (i} NP Salary $ 85,320 $ 35,550 (ii) Benefits 26% 22,184 9,243 (iii) Overhead Expenses 9,146 3,811 (iv) Total Approved Funding 1 $ 116,650 $ 48,604 (v) nal,;Monthly Pa meut 0 i) Subsequent Monthly Payments 3. $ - 9,721 9,721 1 Maximum annual funding allocation of$116,650 to provide for each NP salary and benefit costs,and a portion of overhead expenses. Any additional costs will need to be planned for by the organization. NP Salary-to a maximum annual of$85,320. .Benefits-inclusive of statutory employer contributions(e.g.CPP,El,etc.) 2 First Monthly Payment-retroactive funding of$19,422 owing for the period November 1,2007 to December 31,2007 to be deposited in conjunction with the January 31,2008 monthly payment of$9,721 for a total deposit of$29,163. 3 Subsequent monthly payments to be deposited in the amount of$9,721 unless otherwise notified. EIgi104 GYO NP 2007_08 Budget Template 0708 Approved Budget Schedule"C" Attached to and forming part of the Agreement between the Ministry of Health and Long-Term Care and the Municipality of Bayham dated the of Financial Report For the Fiscal Period November 1,2007 to March 31,2008 MOHLTC Expenditures' Approved (t) i (2) (3) (4) (5) Budget 1st Quarter j 2nd Quarter i 3rd Quarter Ath Quarter Total Expenditure Categories November 1,2007 Apr 1-Jun 30 i Jul 1-Sep 30 1Nov 1-Dec 31 ! Jan 1-Mar 31 November 1,2007 To Due Due I Due I Due To March 31,2008 July 31,2007 I October 31,2007 I January 31,2008 1 April 30,2008 March 31,2008 t ! I [I+2+3+4) Expenditures: t a/a ! n/a I (i) NP Salary $ 35,550 I I ! $ - (ii) Benefits 26% 9,243 I I (iii) Overhead Expenses 3,811 1 ! i - _Total Expenditures $ 48,604 $ - 1$ - i$ _ - i $_ -_$ - t Expenditures-report actual expenditures that are related to Ministry funding only. In Kind Funding Contribution(s)and/or resources received from the community and/or organization are to he separately identified and reported in the section below. -1In Bind Cand rbntron(s)-1tkt type t i, '� I ! Q ! 1st Quarier 2nd Qaarter ! 3rd uuter I 4th Quarter Total ! I (u) I : I - Sul) : E ! I E - (a") i i - i I (v,) ) I I i - (vu) j, I i I I (flirt ! - I I 7otwlInBundConn nbntrons I$ - i$ - '� _ - I $ - $ - 1 In Kind Contributions-identify and report funding contribution(s)and/or in kind resources received from the community and/or sponsoring organization. Please complete the above information and submit in accordance with the due date to: Ministry of Health and Long-Term Care Interdisciplinary Practitioner Program,Primary Health Care Team 80 Queen Street,3rd Floor Kingston ON K7K 6W7 Approved By: Dated: Elgi104 GYO NP 2007_08 Budget Template Sched C Fin Rep Schedule"D" Attached to and forming part of the Agreement between the Ministry of Health and Long-Term Care and the Municipality of Baybam dated the of Performance Report For The Fiscal Period November 1,2007 to March 31,2008 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Apr 1-Jun 30 Jul 1-Sep 30 Nov 1-Dec 31 Jan 1-Mar 31 November 1,2007 Due Due Due Due To July 31,2007 October 31,2007 January 31,2008 April 30,2008 March 31,2008 (a) Patient Encounter n/a n/a E.Number of patients encountered in clinic/reg hours - .Number seen in extended hours/or on call - .Number seen outside of clinic(eg Home,LTC,hospital) - .Patient phone calls>5 mins - (b) Disease Prevention Strategies (i)Immunizations(exclusive of injections): .Routine childhood at 18 mo or before I.Routine childhood at age 4 or over - .Influenza - .Tetanus - .Pneumovax - .Other(hepatitis A/B vaccine) - .Other .Other .Other _ - .Other _ - (ii)Screening: Routine prenatal care with antenatal screening(II/S,GTT) - .HD-Heart Disease(using CMAJ guidelines) - .DM-Diabetes Mellitus(CMAI guidelines) - .BC-Breast Cancer(clinical exam and/or screening mammn) _ - .CC-Colo/rectal Cancer(Hemoccult testing) - .PAP -Cervical CA Screen(Pap) - .STD-Sexually Transmitted Diseases(swabs) - .Osteoporosis(hi-risk questionnare BMD) - .Mental Health screen(depression,dementia) - .Infectious Diseases(TB testing,rubella.VDRL,HIV) - .Well Baby/Child(Rourke Screening Tool) - Other e.g.domestic abuse,CAGE screening for ETOH abuse - .Other e.g pre-op assessment - .Other - - .Other - .Other _ - .Other E1gi104 GYO NP 2007_08 Budget Template Sched D Performance Schedule"D" Attached to and forming part of the Agreement between the Ministry of Health and Long-Term Care and the Municipality of Bayham dated the of Performance Report For The Fiscal Period November 1,2007 to March 31,2008 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Apr 1-Jun 30 Jul 1-Sep 30 Nov 1-Dec 31 Jan 1-Mar 31 November 1,2007 Due Due Due Due To July 31,2007 October 31,2007 January 31,2008 April 30,2008 March 31,2008 (c) Curative Care,diagnoses and Tx .Acute episodic minor illness - Acute/episodic minor injury(e.g.suturing,removal of FB) - .Acute/complex major illness - .Major injury - .Abnormal finding requiring follow up - .Other procedures(e.g.Allergey shot,B12,etc.) - (d) Rehabrlitative Care .Initial visit or tx of a chronic disease - Adjustment of tx for a chronic disease - .Monitoring of a stable chronic illness - .Injury: Ongoing Care(e.g.bum dressings,wound care,etc.) - .Disability:Ongoing Care .Other - (e) Supportive Care .Education or promotion of self-care - .Advocacy - .Counselling(e.g.contraception/smoking cessation) - .Palliative care - .Coordinate/link to community /social services/navigation - (f) Consultations/Referrata Number of consultations with GP/FP - Number of referrals from GP/FPs - Number of referrals from other Health Care Professionals _ - Number of referrals to GP/FPs _ - Number of referrals to Other Medical Professionals - Number of referrals to Rehab Professionals(OT,PT,etc.) _ - Number of referrals to Social Worker - Number of referrals to Dietician - Number of referrals to Mental Health Professionals Number of referrals to Emergency Department - Number of referrals to Other - Please refer to the Tip Sheet-Completing Schedule"D"Performance Report for guidelines on how to complete the above information. Please submit in accordance with the due date to: Ministry of Health and Long-Term Care Interdisciplinary Practitioner Program,Primary Health Care Team 80 Queen Street,3rd Floor,Kingston ON K7K 6W7 Approved By: Dated: Elgi 104 GYO NP 2007_08 Budget Template Soiled D Performance Schedule"D" Attached to and forming part of the Agreement between the Ministry of Health and Long-Term Care and the Municipality of Bayham dated the Alf Performance Report For The Fiscal Period November 1,2007 to March 31,200S 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter (g) Workshops/Seminars provided to patientc/tommwaities(List date topic and number of attendees) Apr 1-Jun 30 Jul 1-Sep 30 Oct 1-Dec 31 Jan 1-Mar 31 (QI) 1st Quarter: n/a (Q2) 2nd Quarter: n/a E1gi104 GYO NP 2007_0$Budget Template Schedule D Workshop Schedule"D" Attached to and forming part of the Agreement between the Ministry of Health and Long-Term Care and the Municipality of Bayham dated the of Performance Report For The Fiscal Period November 1,2007 to March 31,2008 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter (g) Workshops/Seminars provided to patients/communities(list date,topic and number of attendees; Apr 1-Jun 30 Jul 1-Sep 30 Oct 1-Dec 31 Jan 1-Mar 31 (Q3) 3rd Quarter. (Q4) 4th Quarter: Please refer to the Tip Sheet-Completing Schedule D"Performance Report"for guidelines on how to complete the above information and submit in accordance with the due date to: Ministry of Health and Long-Term Care Interdisciplinar;Practitioner Program,Primary Health Care Team 80 Queen Street,3rd Floor,Kingston ON 1C7K 6W7 Approved By: Dated: Elgi 104 GYO NP 2007_08 Budget Template Schedule D Workshop Schedule "E" Attached to and forming part of the agreement between the Ministry of Health and Long-Term Care and the Municipality of Bayham dated the day of 2008. Grow Your Own Nurse Practitioner Agreement Eigi104 Schedule E Schedule "F" Attached to and forming part of the agreement between the Ministry of Health and Long-Term Care and the Municipality of Bayham dated the day of 2008. Return of Service Agreement Elgi104 Schedule F